Sterilizations, Hysterectomies and Abortions. 4.6.5.1 In compliance with federal regulations, the Contractor shall cover sterilizations and hysterectomies, only if all of the following requirements are met: • The Member is at least twenty-one (21) years of age at the time consent is obtained; • The Member is mentally competent; • The Member voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation; • At least thirty (30) Calendar Days, but not more than one hundred and eighty (180) Calendar Days, have passed between the date of informed consent and the date of sterilization, except in the case of premature delivery or emergency abdominal surgery. A Member may consent to be sterilized at the time of premature delivery or emergency abdominal surgery, if at least seventy-two (72) hours have passed since informed consent for sterilization was signed. In the case of premature delivery, the informed consent must have been given at least thirty (30) Calendar Days before the expected date of delivery (the expected date of delivery must be provided on the consent form); • An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a Member who is visually impaired, hearing impaired or otherwise disabled; and • The Member is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility. 4.6.5.1.1 In compliance with Federal regulations, the Contractor shall cover sterilizations for P4HB Participants only if all of the following requirements are met: • The P4HB Participant is at least twenty-one (21) years of age at the time consent is obtained; • The P4HB Participant is mentally competent; • The P4HB Participant voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation. • At least thirty (30) Calendar Days, but not more than one hundred and eight (180) Calendar Days, have passed between the date of informed consent and the date of sterilization. • An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a P4HB Participant who is visually impaired, hearing impaired or otherwise disabled; and • The P4HB Participant is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility. 4.6.5.2 A hysterectomy shall be considered a Covered Service only if the following additional requirements are met: • The Member must be informed orally and in writing that the hysterectomy will render the individual permanently incapable of reproducing (this is not applicable if the individual was sterile prior to the hysterectomy or in the case of an emergency hysterectomy); and • The Member must sign and date the Georgia Families Sterilization Request Consent form prior to the Hysterectomy. Informed consent must be obtained regardless of diagnosis or age. 4.6.5.2.1 A hysterectomy shall not be considered a Covered Service for P4HB Participants. 4.6.5.3 Regardless of whether the requirements listed above are met, a hysterectomy shall not be covered under the following circumstances: • If it is performed solely for the purpose of rendering a Member permanently incapable of reproducing; • If there is more than one (1) purpose for performing the hysterectomy, but the primary purpose was to render the Member permanently incapable of reproducing; or • If it is performed for the purpose of cancer prophylaxis. 4.6.5.3.1 Abortions or abortion-related services performed for family planning purposes are not Covered Services. Abortions are Covered Services if a Provider certifies that the abortion is medically necessary to save the life of the mother or if pregnancy is the result of rape or incest. The Contractor shall cover treatment of medical complications occurring as a result of an elective abortion and treatments for spontaneous, incomplete, or threatened abortions and for ectopic pregnancies. 4.6.5.3.2 Abortions or abortion-related services shall not be considered a Covered Service for P4HB Participants. 4.6.5.4 The Contractor shall maintain documentation of all sterilizations, hysterectomies and abortions and provide documentation to DCH upon the request of DCH.
Appears in 2 contracts
Samples: Contract for Provision of Services, Contract for Provision of Services (Wellcare Health Plans, Inc.)
Sterilizations, Hysterectomies and Abortions. 4.6.5.1 In compliance with federal regulations, the Contractor shall cover sterilizations and sterilizations, hysterectomies, and abortions only if all of the following requirements are met: • :
4.6.5.1.1 The Member is at least twenty-one (21) years of age at the time consent is obtained; • ;
4.6.5.1.2 The Member is mentally competent; • ;
4.6.5.1.3 The Member voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation; • ;
4.6.5.1.4 At least thirty (30) Calendar Days, but not more than one hundred and eighty (180) Calendar Days, have passed between the date of informed consent and the date of sterilization, except in the case of premature delivery or emergency abdominal surgery. A Member may consent to be sterilized at the time of premature delivery or emergency abdominal surgery, if at least seventy-two (72) hours have passed since informed consent for sterilization was signed. In the case of premature delivery, the informed consent must have been given at least thirty (30) Calendar Days before the expected date of delivery (the expected date of delivery must be provided on the consent form); • ;
4.6.5.1.5 An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a Member who is visually impaired, hearing impaired or otherwise disabled; and • and
4.6.5.1.6 The Member is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility.
4.6.5.1.1 In compliance with Federal regulations, the Contractor shall cover sterilizations for P4HB Participants only if all of the following requirements are met: • The P4HB Participant is at least twenty-one (21) years of age at the time consent is obtained; • The P4HB Participant is mentally competent; • The P4HB Participant voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation. • At least thirty (30) Calendar Days, but not more than one hundred and eight (180) Calendar Days, have passed between the date of informed consent and the date of sterilization. • An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a P4HB Participant who is visually impaired, hearing impaired or otherwise disabled; and • The P4HB Participant is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility.
4.6.5.2 A hysterectomy shall be considered a Covered Service only if the following additional requirements are met: • :
4.6.5.2.1 The Member must be informed orally and in writing that the hysterectomy will render the individual permanently incapable of reproducing (this is not applicable if the individual was sterile prior to the hysterectomy or in the case of an emergency hysterectomy); and • and
4.6.5.2.2 The Member must sign and date the Georgia Families Sterilization Request Consent a “Patient’s Acknowledgement of Prior Receipt of Hysterectomy Information” form prior to the Hysterectomy. Informed consent must be obtained regardless of diagnosis or age.
4.6.5.2.1 A hysterectomy shall not be considered a Covered Service for P4HB Participants.
4.6.5.3 Regardless of whether the requirements listed above are met, a hysterectomy shall not be covered under the following circumstances: • :
4.6.5.3.1 If it is performed solely for the purpose of rendering a Member permanently incapable of reproducing; • ;
4.6.5.3.2 If there is more than one (1) purpose for performing the hysterectomy, but the primary purpose was to render the Member permanently incapable of reproducing; or • or
4.6.5.3.3 If it is performed for the purpose of cancer prophylaxis.
4.6.5.3.1 4.6.5.4 Abortions or abortion-related services performed for family planning purposes are not Covered Services. Abortions are Covered Services if a Provider certifies that the abortion is medically necessary to save the life of the mother or if pregnancy is the result of rape or incest. The Contractor shall cover treatment of medical complications occurring as a result of an elective abortion and treatments for spontaneous, incomplete, or threatened abortions and for ectopic pregnancies.
4.6.5.3.2 Abortions or abortion-related services shall not be considered a Covered Service for P4HB Participants.
4.6.5.4 4.6.5.5 The Contractor shall maintain documentation of all sterilizations, hysterectomies and abortions and provide documentation to DCH upon the request of DCH.
Appears in 2 contracts
Samples: Contract for Provision of Services (Centene Corp), Contract (Wellcare Health Plans, Inc.)
Sterilizations, Hysterectomies and Abortions. 4.6.5.1 In compliance with federal regulations, the Contractor shall cover sterilizations and hysterectomies, only if all of the following requirements are met: • :
4.6.5.1.1 The Member is at least twenty-one (21) years of age at the time consent is obtained; • ;
4.6.5.1.2 The Member is mentally competent; • ;
4.6.5.1.3 The Member voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation; • ;
4.6.5.1.4 At least thirty (30) Calendar Days, but not more than one hundred and eighty (180) Calendar Days, have passed between the date of informed consent and the date of sterilization, except in the case of premature delivery or emergency abdominal surgery. A Member may consent to be sterilized at the time of premature delivery or emergency abdominal surgery, if at least seventy-two (72) hours have passed since informed consent for sterilization was signed. In the case of premature delivery, the informed consent must have been given at least thirty (30) Calendar Days before the expected date of delivery (the expected date of delivery must be provided on the consent form); • ;
4.6.5.1.5 An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a Member who is visually impaired, hearing impaired or otherwise disabled; and • and
4.6.5.1.6 The Member is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility.
4.6.5.1.1 In compliance with Federal regulations, the Contractor shall cover sterilizations for P4HB Participants only if all of the following requirements are met: • The P4HB Participant is at least twenty-one (21) years of age at the time consent is obtained; • The P4HB Participant is mentally competent; • The P4HB Participant voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation. • At least thirty (30) Calendar Days, but not more than one hundred and eight (180) Calendar Days, have passed between the date of informed consent and the date of sterilization. • An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a P4HB Participant who is visually impaired, hearing impaired or otherwise disabled; and • The P4HB Participant is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility.
4.6.5.2 A hysterectomy shall be considered a Covered Service only if the following additional requirements are met: • :
4.6.5.2.1 The Member must be informed orally and in writing that the hysterectomy will render the individual permanently incapable of reproducing (this is not applicable if the individual was sterile prior to the hysterectomy or in the case of an emergency hysterectomy); and • and
4.6.5.2.2 The Member must sign and date the Georgia Families Sterilization Request Consent a “Patient’s Acknowledgement of Prior Receipt of Hysterectomy Information” form prior to the Hysterectomy. Informed consent must be obtained regardless of diagnosis or age.
4.6.5.2.1 A hysterectomy shall not be considered a Covered Service for P4HB Participants.
4.6.5.3 Regardless of whether the requirements listed above are met, a hysterectomy shall not be covered under the following circumstances: • :
4.6.5.3.1 If it is performed solely for the purpose of rendering a Member permanently incapable of reproducing; • ;
4.6.5.3.2 If there is more than one (1) purpose for performing the hysterectomy, but the primary purpose was to render the Member permanently incapable of reproducing; or • or
4.6.5.3.3 If it is performed for the purpose of cancer prophylaxis.
4.6.5.3.1 4.6.5.4 Abortions or abortion-related services performed for family planning purposes are not Covered Services. Abortions are Covered Services if a Provider certifies that the abortion is medically necessary to save the life of the mother or if pregnancy is the result of rape or incest. The Contractor shall cover treatment of medical complications occurring as a result of an elective abortion and treatments for spontaneous, incomplete, or threatened abortions and for ectopic pregnancies.
4.6.5.3.2 Abortions or abortion-related services shall not be considered a Covered Service for P4HB Participants.
4.6.5.4 4.6.5.5 The Contractor shall maintain documentation of all sterilizations, hysterectomies and abortions and provide documentation to DCH upon the request of DCH.
Appears in 1 contract
Samples: Contract for Provision of Services (Amerigroup Corp)
Sterilizations, Hysterectomies and Abortions. 4.6.5.1 In compliance with federal regulations, the Contractor shall cover sterilizations and hysterectomies, only if all of the following requirements are met: • :
4.6.5.1.1 The Member is at least twenty-one (21) years of age at the time consent is obtained; • ;
4.6.5.1.2 The Member is mentally competent; • ;
4.6.5.1.3 The Member voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation; • ;
4.6.5.1.4 At least thirty (30) Calendar Days, but not more than one hundred and eighty (180) Calendar Days, have passed between the date of informed consent and the date of sterilization, except in the case of premature delivery or emergency abdominal surgery. A Member may consent to be sterilized at the time of premature delivery or emergency abdominal surgery, if at least seventy-two (72) hours have passed since informed consent for sterilization was signed. In the case of premature delivery, the informed consent must have been given at least thirty (30) Calendar Days before the expected date of delivery (the expected date of delivery must be provided on the consent form); • ;
4.6.5.1.5 An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a Member who is visually impaired, hearing impaired or otherwise disabled; and • and
4.6.5.1.6 The Member is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility.
4.6.5.1.1 In compliance with Federal regulations, the Contractor shall cover sterilizations for P4HB Participants only if all of the following requirements are met: • The P4HB Participant is at least twenty-one (21) years of age at the time consent is obtained; • The P4HB Participant is mentally competent; • The P4HB Participant voluntarily gives informed consent in accordance with the State Policies and Procedures for Family Planning Clinic Services. This includes the completion of all applicable documentation. • At least thirty (30) Calendar Days, but not more than one hundred and eight (180) Calendar Days, have passed between the date of informed consent and the date of sterilization. • An interpreter is provided when language barriers exist. Arrangements are to be made to effectively communicate the required information to a P4HB Participant who is visually impaired, hearing impaired or otherwise disabled; and • The P4HB Participant is not institutionalized in a correctional facility, mental hospital or other rehabilitative facility.
4.6.5.2 A hysterectomy shall be considered a Covered Service only if the following additional requirements are met: • :
4.6.5.2.1 The Member must be informed orally and in writing that the hysterectomy will render the individual permanently incapable incapble of reproducing (this is not applicable if the individual was sterile prior to the hysterectomy or in the case of an emergency hysterectomy); and • Revised 5/19/2008
4.6.5.2.2 The Member must sign and date the Georgia Families Sterilization Request Consent a "Patient's Acknowledgement of Prior Receipt of Hysterectomy Information" form prior to the Hysterectomy. Informed consent must be obtained regardless of diagnosis or age.
4.6.5.2.1 A hysterectomy shall not be considered a Covered Service for P4HB Participants.
4.6.5.3 Regardless of whether the requirements listed above are met, a hysterectomy shall not be covered under the following circumstances: • :
4.6.5.3.1 If it is performed solely for the purpose of rendering a Member permanently incapable of reproducing; • ;
4.6.5.3.2 If there is more than one (1) purpose for performing the hysterectomy, but the primary purpose was to render the Member permanently incapable of reproducing; or • or
4.6.5.3.3 If it is performed for the purpose of cancer prophylaxis.
4.6.5.3.1 4.6.5.4 Abortions or abortion-related services performed for family planning purposes are not Covered Services. Abortions are Covered Services if a Provider certifies that the abortion is medically necessary to save the life of the mother or if pregnancy is the result of rape or incest. The Contractor shall cover treatment of medical complications occurring as a result of an elective abortion and treatments for spontaneous, incomplete, or threatened abortions and for ectopic pregnancies.
4.6.5.3.2 Abortions or abortion-related services shall not be considered a Covered Service for P4HB Participants.
4.6.5.4 4.6.5.5 The Contractor shall maintain documentation of all sterilizations, hysterectomies and abortions and provide documentation to DCH upon the request of DCH.
Appears in 1 contract
